Sex differences in disease progression in Alzheimer patients with different concomitant medications.

Objectives: To examine potential sex differences in cognitive and functional progression rates in Alzheimer’s disease (AD) between patients with different concomitant medications. Methods: The Swedish Alzheimer Treatment Study is a prospective, observational, multicentre study in clinical practice undertaken at the initiation of cholinesterase inhibitor therapy in 1,021 patients diagnosed with mild-to-moderate AD. Participants were investigated using cognitive and activities of daily living (ADL) assessment scales at baseline and every 6 months over 3 years. Concomitant medications were recorded at baseline. Results: The annual cognitive decline was faster in men receiving antihypertensive/cardiac therapy than in non-users (p=0.045); this difference was not observed in women. Cognitive decline was faster in women receiving anxiolytics/sedatives/hypnotics vs. non-users (p=0.024), and slower in women receiving lipid-lowering agents vs. non-users (p=0.035); these differences were not found in men. Faster instrumental ADL (IADL) deterioration/year was exhibited among men receiving NSAIDs/acetylsalicylic acid compared with non-users (p=0.023); this difference was not detected among women. Those who received anti-depressants (both sexes) showed a faster IADL decline than non-users (p≤0.021). Moreover, women receiving anti-depressants had a faster basic ADL deterioration vs. non-users (p=0.013); this difference was not demonstrated in men. No differences in disease progression were observed in women between users and non-users of oestrogen. Conclusions: Various concomitant medications and comorbidities might affect the cognitive and functional outcomes of AD differently in men and women. This is important knowledge that increases our understanding of the impact of subgroups, based on patient characteristics and clinical factors, on progression and prognosis in AD patients.